Temporal Trends of Medical Cost and Cost-Effectiveness in Sepsis Patients -A Japanese Nationwide Medical Claims Database-the Japan Sepsis Alliance (JaSA) Study Group

Abstract Background:Sepsis is the leading cause of death worldwide. Although the mortality of sepsis patients has been decreasing over the past decade, the trend of medical costs and cost-effectiveness for sepsis treatment remains insufficiently determined.Methods:We conducted a retrospective study using the nationwide medical claims database of sepsis patients in Japan between 2010 and 2017. After selecting sepsis patients with a combined diagnosis of presumed serious infection and organ failure, patients over the age of 20 were included in this study. The primary outcome was the annual trend of the effective cost per survivor, calculated from the gross medical cost and number of survivors per year. Subsequently, we performed subgroup and multiple regression analyses to determine the significant predictors contributing to an increase in medical cost.Results:Among 50,490,128 adult patients with claims, a total of 1,276,678 patients with sepsis were selected from the database. Yearly gross medical costs to treat sepsis gradually increased over the decade from $3.04 billion in 2010 to $4.38 billion in 2017 (rate = + $0.2 billion/year, p < 0.0001), whereas the total medical cost per hospitalization declined (rate = - $1,001/year, p < 0.0001). While the survival rate of sepsis patients improved during the study period, the effective cost per survivor significantly decreased (rate = - $1,723/year, p = 0.001). In the subgroup analysis, the gross medical cost of the late elderly (75 ≤ age) showed the highest coefficient throughout the time period, despite the lowest medical cost per person. While gender (male), number of chronic diseases, intensive care unit (ICU) admission, length of hospital stay, and site of infection (blood, heart, and meninges/brain/spinal cord) contributed to an increase in medical costs, an increase in age, admission year, and other types of infection (abdominal, bone and soft tissue, respiratory, and urogenital) were significant predictors of reduced medical costs.Conclusions:We demonstrated an increase in annual gross medical costs with an improvement in annual cost-effectiveness in patients with sepsis between 2010 and 2017. Among the various factors altering medical costs, gender (male), number of chronic diseases, ICU admission, length of hospital stay, and specific types of infection were associated with increased medical expenses.